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The retrospective analysis of clinical cases with corneal injuries secondary to a case diagnosed with Nocardia veterana keratitis by mass spectrometry Hitomi Kobayashi 1,2 , Hideki Fukuoka 2 , Kaori Matsumoto 2 , Mayumi Ueta 2 , Chie Sotozono 2 1Department of Ophthalmology, Japanese Red Cross Kyoto Daini Hospital 2Department of Ophthalmology, Kyoto Prefectural University of Medicine pp.1247-1251
Published Date 2022/9/15
DOI https://doi.org/10.11477/mf.1410214501
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Abstract Purpose:To report a case of Nocardia veterana keratitis identified by the causative organism(MALDI-TOF MS).

Case:A 78-year-old man with follicular lymphoma was treated with lenalidomide and rituximab and was stable. Since 7 months, he had become aware of his left eye vision loss and foreign body sensation and consulted a nearby doctor. He was diagnosed with herpes keratitis and started aciclovir eye ointment, but no improvement was seen and he was referred to another nearby doctor four months later. He added valacyclovir, betamethasone, and prednisolone 50 mg, but his ocular findings did not improve and he was referred to our hospital. At the time of referral, the visual acuity of the left eye was counting finger, and petal-like white deposits characteristic of the parenchymal superficial layer of the left cornea were observed. Anterior chamber inflammation and hypopion were also observed. Suspected corneal infection, corneal scraping and culture examination were performed, and Gram-positive bacilli were detected, and gatifloxacin eye drops, cefmenoxime eye drops, and erythromycin/colistin eye ointment were started. Symptoms also improved. N. veterana was identified via culture testing and mass spectrometry, and was highly resistant to new quinolone antibiotics in drug susceptibility testing.

Conclusions:N. veterana has been reported to cause respiratory infections in immunocompromised patients, but no cases of keratitis have been reported in Japan. In this case, mass spectrometry was useful for identifying the causative organism in addition to the microscopic examination and culture examination of the corneal scrapes.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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